Musculoskeletal procedures

The specialists within the MSK Imaging and Intervention Section at VCU Health perform minimally-invasive, image-guided procedures on the skeletal and muscular systems. These include therapeutic spine and joint injections for diagnosis and pain relief, removal of fluids or fragments (aspiration), bone biopsies, and tumor ablation. Our full-time radiologists are certified by the American Board of Radiology and have more than 50 years of combined musculoskeletal experience.

Our goal is to make the entire patient experience, from image through procedure, as painless as possible. Some common procedures include:

Lumbar Epidural Steroid Injections

Anti-inflammatory medicine is injected into the spine to decrease inflammation of the nerve roots. When effective, this reduces pain in your back or legs. Reducing inflammation can sometimes help injured nerve roots heal. It can provide permanent relief, or pain relief that lasts several months while the injury or other cause of pain heals.

About the procedure

You will lay on your stomach on an x-ray table. Prior to the epidural injection, which is given near the base of the spine, the skin is numbed with an anesthetic. Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space of your spine and uses a small amount of contrast (dye) to verify that the needle is in the correct position. The physician then injects a long-acting pain medication (Bupivacaine) and the steroid. An epidural steroid injection usually takes between 20 and 30 minutes, and the patient is observed for about 15 minutes after the anesthetic takes effect. Most often, the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure. You may have some cramping or pressure as the medications are injected.

After the procedure

Most patients feel improvement in their pain immediately after the injection, due to the anesthetic, which might only last for 10 to 12 hours after the procedure, and then their pain could return. The steroid takes three to five days to start to have an effect in most people and peaks in about two weeks. There might be some tenderness near the site of the injection for a couple of days after the injection; an ice pack can help. Patients may take their usual pain medications after the injection.

We recommend no heavy lifting or exercise, no prolonged standing or walking, and decreased stair climbing and bending for three days after the procedure. This will help your back relax as the steroids are working to decrease the inflammation in your back. Download lumbar injection information.

Joint Aspiration

Joint aspiration can be helpful in relieving joint swelling and pain by removing fluid from the joint. Occasionally, cortisone anti-inflammatory medications are injected into the joint during the joint aspiration to rapidly relieve pain and further reduce symptoms.

About the procedure

You will lay on your back on an x-ray table, and the skin over the joint is cleansed with antiseptic soap and then numbed with an anesthetic. Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the joint space and will try to draw fluid from the joint using a syringe. If fluid cannot be obtained, some sterile saline (salt water) will be injected into the joint to try to “wash out” any infection. A small amount of contrast (dye) will be injected into the joint, to verify that the needle is in the correct position. A joint injection usually takes 10 to 20 minutes, and the patient will be observed for about 20 minutes after the procedure.

After the procedure

You may have pressure or pain in the joint, though it will be relieved within several hours after the procedure. If you experience pain, you may apply an ice pack and take a non-aspirin pain reliever to help your symptoms. You should not participate in any exercise activities for 24 hours after the procedure. Download joint aspiration information.

Joint Injection

A joint injection is the administration of a corticosteroid and anesthetic (numbing medication) directly into the joint.  There are many joints throughout the body that can be injected.  This procedure provides valuable information on the source of your pain and could reduce inflammation, resulting in long-term pain relief.

The shoulder and hip are the most common joints in the body to be injected. However, we can also inject the ankle, wrist, and elbow joints, which are usually inflamed due to overuse injuries or arthritic changes.

We also perform injections on:

• the facet joints on the spine, which gives people stability and the ability to bend and twist. If these joints become painful (usually due to trauma or arthritic changes) they might cause pain in the lower back.
• the SI Joint (sacroiliac joint), a small joint in the region of the lower back and buttocks where the pelvis actually joins with the spine. If the joints become painful (usually due to trauma or arthritic changes), it could cause pain in the lower back, buttocks, abdomen, groin or legs.
• the sacrococcygeal joint, formed between the oval surface of the sacrum and the base of the coccyx (tailbone). If the joint shifts, most likely from trauma, it can cause pain in the low back, buttocks, or legs.

About the procedure

You’ll be asked to lie flat on an x-ray table, either on your back or stomach (depending on which joint is being injected).  The skin over the joint is cleansed with antiseptic soap and numbed with local anesthesia. Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the joint space. 

The physician uses a small amount of contrast (dye) to verify that the needle is in the correct position, and then injects a long-acting pain medication (Marcaine) and a steroid. Steroids can provide a very potent anti-inflammatory effect. Most often, the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure. You might have some cramping or pressure as the medications are injected.

After the procedure

A joint injection usually takes 15 to 20 minutes, and patients are observed for about 15 minutes. 

Most patients experience pain reduction immediately after the injection, due to the anesthetic, which might only last up to six hours after the procedure before the pain returns. The steroid takes three to five days to have an effect in most people, and peaks in about two weeks. Therefore, it might be a while before a change in pain occurs. Some tenderness near the site of the procedure may be experienced for a few days after the injection; an ice pack can help (never use heat or bathe in hot water). You may take your usual medications after the injection.

We recommend no heavy lifting or exercise, no prolonged standing or walking, and decreased stair climbing and bending for three days after the procedure to help joints relax as steroids work to decrease inflammation. Download joint injection information.